Atrophic vaginitis

Inflammation of the vaginal mucosa is not always infectious. During the period of fading fertility, the production of female sex hormones - estrogens - decreases, which affects the condition of the reproductive organs. The ovaries and uterus decrease in size, the walls become thinner, flabby and the diameter of the vaginal lumen narrows. Atrophic vaginitis is a complex of inflammatory symptoms associated with insufficient blood supply, and therefore - adequate nutrition of the tissues that make up the walls of the vagina. It is also called senile (senile) or postmenopausal colpitis, since, basically, this condition develops during the period of age-related involution.

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Epidemiology

Statistics on visits regarding vaginal discomfort indicate that on average, seven to eight out of ten postmenopausal women (58 years and older) have this problem caused by atrophic changes in the vagina. This condition manifests itself five to seven years after the onset of menopause.

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Causes atrophic vaginitis

A decrease in estrogen production and a deficiency of these female sex hormones leads to the development of an inflammatory process in the vagina.

Normal hormonal levels ensure the proliferation of cells of the vaginal epithelium mucosa, the production of vaginal secretions and blood supply to the tissues, that is, their nutrition and respiration.

Deficiency of these hormones leads to the development of atrophic changes - the vaginal walls become thinner, smoother (normally they resemble small corrugations), the vaginal lumen narrows. The acidic environment of the vagina, which restrains the development of opportunistic microorganisms, also gradually becomes alkaline. Microbes get the opportunity to multiply. These processes contribute to the appearance of chronic recurrent inflammation - atrophic vaginitis.

Risk factors for such developments are associated with a decrease in estrogen production, which in turn is caused by physiological aging. In the postmenopausal period, the ovaries produce less and less estrogen because they are no longer needed, and many women in this age group begin to notice painful symptoms.

In addition, atrophic processes in the vagina can be the result of surgical (oophorectomy) or drug-induced (taking drugs that suppress estrogen production or their effects) menopause.

Radiation therapy of the pelvic organs, endocrine pathologies, drug therapy, adherence to strict diets, anorexia, severe mental shocks, bad habits are also considered among the factors that increase the likelihood of developing atrophic vaginitis.

The pathogenesis of inflammation is triggered by the above reasons or their combination. The multilayered flat vaginal epithelium gradually becomes thinner. Its cells, which normally contain glycogen, are replaced by connective tissue, which leads to a significant decrease in the number of Doderlein bacilli (lactobacilli) and the development of opportunistic flora. The number of collagen fibers decreases and the elasticity of the organ walls decreases. They are more easily damaged and sag.

Estrogen deficiency also leads to insufficient production of mucus, which contains substances that have an antibacterial effect (lysozyme, lactofferrin, defensins, zinc).

Multiple petechial bleeding at the beginning of the atrophic process is usually combined with aseptic inflammation. Pain during sexual intercourse, itching and burning, especially with irritation of the external genitalia, are considered a consequence of hypoxia and the spread of the atrophic process to the area of the labia minora. The tissues of the vaginal ring also become sclerotic (kraurosis vulvae). It is believed that vaginal discharge, which also occurs with aseptic inflammation, is caused by damage to the lymphatic vessels (lymphorrhagia or lymphorrhagia). This condition is usually resistant to hormonal therapy. All of the above processes create very favorable conditions for secondary infection. The consequence of disruption of the normal vaginal ecosystem is chronic inflammation localized in the vagina.

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Symptoms atrophic vaginitis

The first signs are expressed by minor discomfort, which women often do not pay much attention to. Basically, this is dryness of the vaginal epithelium, lack of lubrication, which experts associate with insufficient blood circulation in the vessels of the vaginal wall. Consequently, atrophic changes develop not only in the epithelium, but also in the vascular network, as well as the muscular corset of the wall. It is assumed that oxygen starvation leads to the growth of the capillary network, noticeable during visual examination and being a specific sign of atrophic vaginitis. The presence of a large number of capillaries in the epithelium also explains the high contact bleeding.

Atrophic changes occur gradually and symptoms increase with them - hypoxic changes look like multiple ulcers in the epithelial membrane. Atrophy of the cervix and the uterus itself becomes noticeable, their size ratios become 1:2, which is typical for childhood.

Discharge in atrophic vaginitis is insignificant. It looks like thin watery leucorrhoea (aseptic inflammation). Patients often complain of dryness and burning in the vagina, more pronounced during urination or hygiene procedures. They may be bothered by discomfort in the lower abdomen, itching and a burning sensation in the area of the external genitalia.

Sexual intimacy no longer brings pleasure, since the vaginal secretion is not sufficient. Due to the lack of lubrication, women may experience pain during sexual intercourse, and after it, minor bloody discharge sometimes appears. The thin and dry vaginal epithelium is easily damaged and quickly begins to bleed.

Secondary infection is manifested by symptoms characteristic of an additional infection: cheesy white flakes - with candidiasis, greenish - with the proliferation of purulent flora, etc.

Atrophic vaginitis, like all chronic diseases, occurs in waves - exacerbations are replaced by a latent period, when symptoms are completely absent. The disease is sluggish in nature, pronounced signs of inflammation appear at a late stage of the disease or when a secondary infection occurs.

Types of atrophic changes in the vaginal epithelium are considered from the point of view of the causes that caused the onset of menopause. Postmenopausal atrophic vaginitis is the result of natural aging of the body. A similar condition acquired as a result of artificial menopause is considered separately.

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Complications and consequences

Acid-base imbalance leads to vaginal dysbacteriosis and unhindered proliferation of pathogenic microorganisms.

Violation of tissue trophism, destructive changes in them can lead to prolapse of the vaginal walls and prolapse of the uterus, which can result in blockage of the urethra and disruption of urine flow. By the age of eighty, 20% of women suffer from prolapse of the genitals, the main method of eliminating this pathology is surgical treatment.

Atrophic vaginitis is often complicated by frequent cystitis, urinary incontinence and other problems of the genitourinary system.

Lack of interest in sexual activity caused by decreased estrogen levels and discomfort during and after intercourse can cause the destruction of family relationships.

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Diagnostics atrophic vaginitis

The doctor, having listened to the patient's complaints and her answers to the questions of interest to him, conducts an examination on a gynecological chair, during which smears are taken from the vagina and cervix for microscopic examination. Cytological (to determine cellular changes) and bacterioscopic (for flora) analyses of the collected biological material are made.

The atrophic type of smear on the cytogram shows that the epithelial layer contains basal cells and leukocytes. This indicates almost complete destruction of the vaginal mucosa and severe estrogen deficiency. This type of smear corresponds to the diagnosis of atrophic vaginitis.

A milder degree of atrophy corresponds to a smear that, in addition to basal cells and leukocytes, contains intermediate - parabasal cells. Sometimes there is no inflammation, then leukocytes are absent. But the presence of basal cells indicates the beginning of the atrophic process.

Instrumental diagnostics necessarily include colposcopy, which allows for good visualization of the vaginal mucosa and the adjacent part of the cervix. This examination allows for the thinning of the walls and foci of hemorrhage on them to be seen. Patients who do not suffer from iodine sensitization undergo the Schiller test during colposcopy. If the tissues are poorly and unevenly stained, their atrophic changes are diagnosed.

Additionally, it is recommended to examine vaginal and cervical secretion material using polymerase chain reaction to detect latent infections.

If necessary, an ultrasound of the pelvic organs, general blood and urine tests may be prescribed.

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Differential diagnosis

Differential diagnosis of atrophic vaginitis is carried out with inflammation of the genitourinary organs of infectious etiology.

Treatment atrophic vaginitis

Read more about the treatment of atrophic vaginitis here.

Prevention

Age-related changes cannot be avoided, but they can be met fully armed. It is quite possible to significantly slow down atrophic processes in the vaginal wall by trying to follow not too complicated rules.

Monitor your diet: include foods containing phytoestrogens in your diet. There are many such foods. These are legumes – beans, regular and asparagus, peas, lentils, soybeans; seeds – pumpkin, flax, sesame; vegetables – carrots and beets, tomatoes and even cucumbers; fruits – apples, pomegranates, dates.

Also, regular consumption of fermented milk products helps to normalize the acidity in the vagina, and drinking at least two liters of clean still water per day will maintain the water balance of your body and increase the production of vaginal mucus.

Regular sexual activity improves blood circulation in the pelvic organs and stimulates the production of estrogen.

Comfortable natural underwear and thorough intimate hygiene with neutral hypoallergenic products will play a positive role in the prevention of atrophic vaginitis.

Fat layers in the female body are predetermined by nature, they play an important role in the synthesis of hormones, so you should not get too carried away with fashionable diets or starve. We are not talking about the benefits of excess weight, but its deficiency also has a detrimental effect on the female body.

Do yoga, some asanas stimulate the adrenal glands, others prevent congestion in the pelvic area, do any set of exercises that train the pelvic floor muscles. The World Health Organization, whose authority is beyond doubt, concluded that the development of all pathological processes begins with congestion. Activation of blood circulation prevents their development.

Say goodbye to bad habits, increase your stress resistance, then perhaps you won’t need hormone replacement therapy.

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Forecast

There are quite a few methods for preventing atrophic vaginitis. The main thing is not to neglect the disease and not to engage in self-medication if you still have to resort to hormone replacement therapy. This method has helped many women survive menopause without complications. However, to avoid side effects, it is imperative to follow the medication regimen prescribed by your doctor.

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